Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

Secondary Fracture Prevention in Home Health Care: Initial Results from a Group Randomized Trial.

Kilgore2,  Meredith L., Curtis4,  Jeffrey R., Outman5,  Ryan C., Locher1,  Julie, Allison3,  Jeroan, Saag5,  Kenneth G.

Univ of Alabama at Birmingham, Birmingham, AL
Univ of Alabama at Birmingham
Univ of Massachusetts, Worcester, MA
University of Alabama-Birmingham, Birmingham, AL
University of Alabama-Birmingham, Birmingham, AL

Statement of Purpose:

To develop and evaluate a multimodal intervention to increase rates of osteoporosis treatment in high risk patients receiving home health services.


We developed and tested an intervention to improve the rates of treatment, particularly use of prescription osteoporosis drugs, among patient with a history of fracture receiving home health services. The intervention included an educational component for nurses, a computerized care plan that prompted the nurse to initiate specific actions related to osteoporosis management, easy reference materials for physicians, prepared order sheets to facilitate osteoporosis drug prescription, and patient education materials focused on osteoporosis, fracture risks, fracture prevention, and medication adherence. Field offices (n=24) of a home health agency operating throughout Alabama were randomized to receive the intervention or serve as controls. The primary outcome measure was the rate of osteoporosis medications prescribed among patients with a fracture history. A t-Test of proportions was used to assess difference between groups

Summary of Results:

We found an absolute difference of 3.9% (NS) between the treatment and control group in post-intervention osteoporosis care. The figure shows the monthly distribution of treatment rates by office before and after the intervention.

Figure 1. Pre- & post-intervention osteoporosis medication prescription rates in intervention and control groups.

While all but one of the treatment offices showed an improvement, overall rates were low, and the corresponding rates in the control arm improved as well.

A secondary analysis tested whether treatment rates increased when the nursing care plan was activated. In this case the difference was 15.3% (p < 0.0001).


Preliminary results do not demonstrate significant efficacy of the intervention overall, but suggest that improvements in processes of care could have significant effects on appropriate osteoporosis care delivery. Future studies should examine the impact of reinforcement of the nursing in-service training with audit and feedback to field offices on their relative performance rates, particularly with respect to activating the nursing care plan.

To cite this abstract, please use the following information:
Kilgore, Meredith L., Curtis, Jeffrey R., Outman, Ryan C., Locher, Julie, Allison, Jeroan, Saag, Kenneth G.; Secondary Fracture Prevention in Home Health Care: Initial Results from a Group Randomized Trial. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1005
DOI: 10.1002/art.28772

Abstract Supplement

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